This competing continuation proposal for grant #R01 HS06208 is for the third year of this three-year project, which aims to create a "Thrombolytic Predictive Instrument" (TPI) to improve the use and outcomes of thrombolytic therapy (TT) for Acute Myocardial Infarction (AMI). The aims are unchanged except for the additions of several enhancements to the TPI capabilities. if given very early in the course of an AMI, and if given to proper candidates, TT may reduce mortality by nearly 50%, being perhaps the most effective single therapy ever devised for AMI. Achieving the potential enormous impact of TT on the most common cause of death in this country depends on developing ways to rapidly deliver TT to suitable AMI victims. Indeed, if given too late, or insufficiently selectively, TT may cause serious complications and incur substantial costs, while yielding little benefit. Creating a large database by combining data from major TT trials, this multicenter collaborative project's aim is to develop a TPI for emergency department (ED) and emergency medical service (EMS) use that will optimize outcomes of TT by 1) specifically identifying those patients likely to benefit from TT, and 2) facilitating the earliest possible TT administration. Analogous to our earlier predictive instrument for coronary care unit admission, the TPI is intended to assist decision-making in acute care clinical settings. Based on multivariate predictive regression models, the TPI will predict: 1) acute mortality; 2) one-year mortality; and 3) complications of TT, including bleeding, strokes, and cardiac arrest. Clinicians will be provided with a 0-100% probability for each of these outcomes, for if TT is used, and if TT is not used, to assist real-time decision-making. Programmed into a computer-assisted self-interpreting electrocardiograph for use in the ED and for mobil use by EMS. An additional product of this project will be a set of AMI outcome predictive models that could be used for making risk-adjusted outcome comparisons between providers of acute medical care for AMI. Indeed, the fact that the tools are clinically valid and useful should enhance their credibility and acceptance for this use. In addition, in Year 03, we will add analyses of risk-adjusted outcomes and of the possibility of underuse for the elderly, those on the fringes of indications for TT, and women.